Provider Demographics
NPI:1609849074
Name:LA MAESTRA FAMILY CLINIC, INC.
Entity Type:Organization
Organization Name:LA MAESTRA FAMILY CLINIC, INC.
Other - Org Name:LA MAESTRA COMMUNITY HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-961-0818
Mailing Address - Street 1:4060 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1608
Mailing Address - Country:US
Mailing Address - Phone:619-961-0818
Mailing Address - Fax:619-281-6738
Practice Address - Street 1:4060 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1608
Practice Address - Country:US
Practice Address - Phone:619-280-4213
Practice Address - Fax:619-281-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70472GMedicaid
CAFHC70472GMedicaid
CA051076Medicare Oscar/Certification